RN's w/chronic pain, using narcotics

lostkitty_1 · Oct 8, 2008

I am so sorry you are having to deal with pain issues. It a horrible and frustrating condition to have to endure (and often terribly misunderstood).
My advice: Call your BON and as them about policies r/t the use of Prescribed Opioids and work.
For example, here in California, a Nurse can practice while taking Prescribed opioids. Patient and non-Patient care.
I called the CA BON a few weeks ago spoke with a Nurse Educator (I called because there are so many threads r/t working and Scheduled meds). She told me that it really comes down to individual facilities and their policies. So, talk with HR and see what policies they have implemented.
As I have stated before in another thread, I would advise you to NOT share the fact that you take pain meds with anyone you work with (except through the hiring procedure...if asked).
Why? Because out of ignorance, many people will become hypercritical about everything you do. Tired? Yawning? Drop something? Forget something? Late? Call is sick? It will always be blamed on the pain meds. and believe me, someone that knows that you are taking those meds will happily volunteer that information for the entire office/floor....only out of concern for you though
The funny thing is, it will be perfectly ok for someone not on pain meds to do the exact same things.
Yes, studies have shown that people can function better with the proper medication. There is also a study debunking the myth that individuals with chronic pain (and their use of opiates) have impaired/delayed reaction times when driving. (Will post that article later).

I would love to see the article of which you speak. I too try to convince others that I do not get high from the medication only some pain relief but predjudice lingers on.

I love my cat! · Oct 18, 2008

i would love to see the article of which you speak. i too try to convince others that i do not get high from the medication only some pain relief but predjudice lingers on.

yes, there is so much prejudice towards people with chronic pain. it's very unfortunate. i would say it is mostly due to lack of education on the topic. i am amazed at the number of people that assume that opioids=impairment. it is just not the case for the majority of those suffering with chronic pain issues.

nyt article

abstract

previous reviewers have concluded that opioids cause dose-related impairment in opioid-naive volunteers on psychomotor skills related to driving. data relating to opioid-dependent/tolerant patients have not yet been reviewed. to determine what evidence, if any, exists for or against opioid-related driving skill impairment in opioid-dependent/tolerant patients, we performed a structured evidence-based review of all available studies addressing the issue of whether opioid-dependent/tolerant patients are impaired in driving-related skills. a computer and manual literature search for studies relating to opioid-dependent/tolerant patients and driving-related skills produced 48 relevant reports. these references were reviewed in detail, sorted, and placed into tabular form according to the following subject areas: (1) psychomotor abilities studies; (2) cognitive function studies; (3) effect of opioid dosing on psychomotor abilities studies; (4) motor vehicle driving violations and motor vehicle accident studies; and (5) driving impairment as measured in driving simulators and off/on road driving studies. for each topic area, each study was categorized for the type of study it represented according to guidelines developed by the agency for health care policy research (ahcpr). the strength and consistency of the evidence in each subject area also then was categorized according to ahcpr guidelines and a quantitative method. this evidence-based review indicated the following: (1) there was moderate, generally consistent evidence for no impairment of psychomotor abilities of opioid-maintained patients; (2) there was inconclusive evidence on multiple studies for no impairment on cognitive function of opioid- maintained patients; (3) there was strong consistent evidence on multiple studies for no impairment of psychomotor abilities immediately after being given doses of opioids; (4) there was strong, consistent evidence for no greater incidence in motor vehicle violations/motor vehicle accidents versus comparable controls of opioid-maintained patients; and (5) there was consistent evidence for no impairment as measured in driving simulators off/on road driving of opioid-maintained patients. based on the above results, it can be concluded that the majority of the reviewed studies appeared to indicate that opioids do not impair driving-related skills in opioid-dependent/tolerant patients. this evidence was consistent in four out of five research areas investigated, but inconclusive in one. as such, additional controlled studies are required. until more data are available, however, physicians may wish to consider the approach to this problem recommended in this review.

....and this article..........

abstract:

objective. to evaluate driving performance, cognition, and balance in patients with chronic nonmalignant pain before and after the addition of transdermal fentanyl to their treatments.

design. prospective, one-group pretest-posttest design.

setting. outpatient pain center associated with a large, urban medical school.

interventions. patients taking less than a 15-mg equivalent of oxycodone per day took baseline driving performance, cognitive, and balance tests. transdermal fentanyl was initiated and titrated in 25-g/hour increments, weighing benefits and side effects. at the end of a 1-month period, the achieved dose was maintained for another month. after they were stabilized for 1 month, patients repeated driving, cognitive, and balance tests.

results. twenty three patients completed the study; three discontinued secondary to side effects. the median dose at the end of the titration period was 50 g/hour (48%). no differences were found in driving simulation measures between the pretreatment and posttreatment periods. no decrements in cognitive performance were found. improvements in visual motor tracking, visual memory, and attention were found during treatment with transdermal fentanyl. no differences in balance or body sway were found. pain decreased over the course of treatment.

conclusions. the addition of transdermal fentanyl to a treatment regimen containing no opiates or small amounts of opiates for patients with chronic nonmalignant pain did not negatively affect their driving performances, reaction times, cognition, or balance. future studies in this area are needed to guide treatment decisions.

Josh L.Ac. · Oct 18, 2008

So the participants in the study we tested while taking a small oral dose of oxycodone, then titrated to a low level of transdermal fentanyl, then tested again with the results compared to their stats while being on oxycodone?

Not meaning to be intentionally obtuse, but how would that design allow one to universalize the results to mean that people on low-dose opiates can function effectively and safely at their jobs?

BigBee48 · Nov 18, 2008

I would like to say"Amen" to everybody that says do not mention to your employer or fellow employees that you must take narcotics. And I mean, have to, I have had chronic pain for approx 10yrs, have 2 surgeries, one on my cervical, w/rods and screws, one on my lumbar another fusion. But I still have 4 herniated discs in my thoracic region. I have experienced great prejudice in the area of taking pain meds and working. I was working as DON in a LTC facility, had 2 nurses that myself and the Administrator turned into the State for abusing a patient. Well they were fired, and it was a small LTC facility, they knew about my chronic pain. They turned me into the BON, had to go in front of them for the complaint. They couldn't find any reason to do anything to me, but because I'm on pain meds I had to go into the Nurses Assist Program. This turned into a nightmare, because it was when the program was taken over by a company out of Michigan. Who hasseled me, constantly my counselor was

telling me I had to get off all meds, even though I still had severe pain. I went to a very good surgeon, who fixed my neck-although I continued to have severe mid & low back pain, they eventually said I was non-compliant with the program, I had my license susp for 3 yrs, I ended up going back to work in the field I was in before Nursing (Law Enforcement) haha-ironic isn't it. But eventually had an additional surgery on my lower back, many procedures on my middle back-with no relief. I am going to a wonderful pain specialist, who I did not tell about this when I first started, because I was tired of being tagged as a drug seeker or addict. I am on the lowest dose of oxycontin and percocet for break through there is, after trying sooo many other meds, like lyrica, which I did run into a post and wrecked my car while taking that. But I cannot get out of bed and function as a Mom and wife, sister, daughter and whatever else I must do, without it. Trust me I've tried, So I'm now going to write the BON to see about getting my license reinstated???? I also tried the Suboxone, did not help with all the degenerated, bulging disc OA, and pain in my trunk, if you will,

but I guess if that's a stipulation to me returning to nursing, I may have to go that route. Oh and just a a side note I took a substantial pay cut to go back to Law Enforcement, but we do drug testing her, they know what I take and why, and have no problems. I know that was windy but I have not really shared that story with very many people, it felt good to get some of it out in open

Earnedit · Jun 1, 2009

I am in favor of never being in pain, medical science allows us to be free from it. However I also have seen impaired nurses who I have had to report due to mistakes, poor judgment and risk to my patients. I also know someone who has gone to a pain clinic and gotten a muscle relaxer, anti anxiety and narcotic pain med in her early 20's as a new nurse. This is the street drug cocktail of choice for young people now. We all know that pain management MD is some states are not legitimate and give pain meds out like candy. Some have even lost there license to practice due to giving large prescriptions and keeping some for themselves to sell on the street!

So how do you determine the nurses who really need it from the ones really in pain? This is a very difficult thing to do for a nurse, employer and the BON. For me personally, you would certainly have to have documented injury, proof of failure of less impairing means to control your pain and do not in anyway appear to be impaired. Remember as Nurses we dont only answer to our employers, the board of nursing, MD's but also our patients. I know that many are saying this is none of an employers business but who is going to protect our patients? We all have too!

I just look at it this way... If my child came into the ER and the nurse taking care of her was on impairing narcotics. Would I risk her life to that nurses judgements?

I know before you finish reading your going to say not all narcotics and doses of narcotics are impairing and I agree! However I also know that some are and those who are not responsible with them give everyone else a bad rep.

I am sorry for those who are in pain and use it responsibly and if we could stop those who abuse it from ruining it for all those nurses who worked so hard and earned there title, I would say go for it but for now I guess it has to be subjective for each of us.

Becoming a nurse is difficult, keeping the license is difficult and managing nurse vs personal life is difficult.

God Bless us all!

BigBee48 · Jun 6, 2009

I first would like to agree with almost everything you stated. I am an RN w/long term chronic pain, have tried

soooo many different meds (to not be impaired, and yet have some sort of pain control, so I can do my job).

I have had so many procedures, and 2 back surgeries to try and correct what is causing the pain, still have 4 herniated discs in my thoracic region, causes so much pain, can't fold clothes w/o pain, wash windows, cook, do dishes, read a book, certainly being on my feet, working as a floor nurse, also I tried a position where I sat most of the day, that also causes alot of pain. I have worked as a nurse for 18 +yrs, I have taken a break to try

other jobs, to see if I can do them w/o pain, still having it. I really don't want to go on disability, I'm only 48 (be 49 on 6/19) and I'm not ready to give it up, I miss it every day, :heartbeat but certainly would never want to be imapired on the job, anywhere, and I have found a low dose of my meds, and regular exercise keeps me going pretty good, there are days when I really want to do more, and just can't, cannot vacuum, sometimes my family wants to go somewhere and I am having a really bad pain day, where I just cannot go with them, they have certainly made sacrifices also. You are 100% correct that there is always one or a few who make everybody look bad, and give us hard working professionals a bad name.:angryfire

giavannapeanut · Jan 16, 2011

You just stated the same thing that my employer said, when I submitted for a drug screen: "As long as the prescribed medication does NOT impair our ability to perform our job..."
I have been taking hydrocodone for the past two years under the supervision of a pain management specialist for treatment of a bulging disc, as I have been informed by my two orthopedic specialists that there are no other treatment options for me. If I thought I could survive the application process for getting on SSI without losing everything I own, I'd stop taking it TODAY and stay AT home. But since I can't, I have to stay functional in order to keep drawing a paycheck. The day that I become impaired, is the day I quit. Until that day comes, I have to keep on working...

What state do you live in?

bubbasmom · Apr 1, 2011

i have been reading this thread and feel everyone's pain...i am wondering how i will be able to apply to nursing school because they said that i would be unable to take narcotic meds for my herniated l5-s1 disk.can someone explain how you can take narcotic meds legally as a rn student? i dont know what to do.im soo upset.i was at the point where i felt i may be able to come off my hydrocodone and this week my disk herniated even furthur- i couldnt sit up, stand or walk.so now what do i do? injections havent worked and i cant afford the surgery.

Hespan · Apr 23, 2012

what i don't understand about this whole thread is this. I have been taking hydrocodone for years and i mean years(3+) and I never had an issue with working while on meds. # 1. When you take your drug test--if they don't ask you up front about your meds then you will pop a positive and the MRO will call and verify your prescription. Once verified you will be NEGATIVE. PERIOD !!! I have always been open and up front with all my my hospitals i have ever worked for and I work in ICU. # 2. everyone is talking about impairment--and who decides who is impaired--i must agree with Granny here in that you would be hard pressed to know i am impaired period with or without meds. # 3. you can't discriminate against a chronic pain nurse or patient--PERIOD !!!!, what about all the nurses taking ADD meds--are they impaired??? doubt it..OH and on top of all this i have proabably taken more Drug tests than most of you have been alive. I can't even count the Number I have taken over the past 15 years

there was a great read about this and the stance the board takes on this back in 2007 for Texas. Read here

http://www.bon.texas.gov/about/pdfs/apr07.pdf

pages 5-6

I don't know what the stance is from other BON's but I do know where i stand in Texas !!!